Created on: 10/4/2024
Posted to the Web on: 10/16/2024
Basic Information
FACILITY CONTACT INFORMATION:
Address: 425 CHINWORTH CT
City: WARSAW
Telephone: (574) 267-3873
Web Site:
NAME CHANGES:
Most recent name change: LAKE CITY PLACE
Date of most recent name change: 9/5/2023 2:28:24 PM
LICENSE INFORMATION:
License number: 24-011389-1
License effective date: 1/10/2024
License expiration date: 12/31/2024
Administration and Staff
Administrator: MARCIE FISHER
Start date: 5/22/2022
Director of Nursing: KRISTINA SHIREY
Start date: 8/2/2021
Medical director:
Start date: / /
Wound care specialist:
Start date: / /
Infection preventionist:
Start date: / /
Ownership
CURENT OWNERSHIP:
Owning corporation: WARSAW AL, LLC
600 THIRD AVE, 21ST FLOOR
NEW YORK NY 10016
Ownership type: PROFIT
Officer(s): ALAN LITT
JONATHAN LITT
THOMAS LALLY
LLC 125 HOLDCO
LLC SALTAIRE PARTNERS
INC SALTPAC HOLDING CO
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: GARDENS AT LAKE AID OPCO LLC
Date of last change of ownership: 1/10/2024
Bed Counts and Census
COMPREHENSIVE CARE BEDS:
Number of Medicaid beds (NF): 0
Number of Medicare beds (SNF): 0
Number of Medicare/Medicaid beds (SNF/NF): 0
Number of non-certified comprehensive care beds (State Licensed only): 0
Total number of comprehensive care beds: 0
RESIDENTIAL CARE BEDS:
Total number of residential beds: 50
Total number of beds in facility: 50
CENSUS:
Facility census: 29
As reported by the facility on: 7/1/2020
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 7/1/2020
Residential care beds occupied: 29
As reported by the facility on: 7/1/2020
Alzheimer Beds: 0
Alzheimer Beds Occupied: 0
As reported by the facility on: / /
Ventilator Beds: 39
Ventilator Beds Occupied: 23
As reported by the facility on: / /
Nurse Aide Training
NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved:
Nurse aide training and competency evaluation program (NATCEP) expires:
Nurse aide training and competency evaluation program (NATCEP) banned: No
Nurse aide training and competency evaluation program (NATCEP) ban expires: N/A
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites:
HAGEN HEALTH EDUCATION
Approved: 7/27/2011
Terminated: N/A
Complaints
NUMBER OF SUBSTANTIATED COMPLAINTS:
Current year: 0
Previous year: 0
2 years previous: 0
State Licensure Surveys
The ISDH conducts a state licensure survey at each licensed residential facility
approximately once per year. If state findings are cited on a survey, the
residential facility may be requested by the ISDH to complete a plan of
correction on how and when they will correct each state finding and who will be
responsible to ensure the corrections are made and will not reoccur in the future.
The plan of correction is generally submitted by the residential facility and
reviewed by the ISDH within fifteen (15) days of the survey.
To read an overview of the survey process, click hereNOTE:
The residential consumer report survey information begins with surveys that
have been completed on or after December 1, 2008. Any survey performed prior
to that date will not have any information in the state findings count rows or
columns or will show zero.
3/19/2024 Most Recent
4/12/2023 2nd Most Recent
2/24/2022 3rd Most Recent
Number of state findings
4
3
7
State Average for the year of the survey (rounded to nearest whole integer).
